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Rapid impact of effective treatment on transmission of multidrug-resistant tuberculosis.
Int J Tuberc Lung Dis. 2014 Sep; 18(9):1019-25.IJ

Abstract

BACKGROUND

Effective treatment for drug-susceptible tuberculosis (TB) rapidly renders patients non-infectious, long before conversion of sputum acid-fast smear or culture to negative. Multidrug-resistant TB (MDR-TB) patients on treatment are currently assumed to remain infectious for months. While the resources required for prolonged hospitalization are a barrier to the scale-up of MDR-TB treatment, the safety of community treatment is clear.

OBJECTIVES

To estimate the impact of treatment on infectiousness among MDR-TB patients.

METHODS

A series of five human-to-guinea pig TB transmission studies was conducted to test various interventions for infection control. Guinea pigs in adjacent chambers were exposed to exhaust air from a hospital ward occupied by mostly sputum smear- and culture-positive MDR-TB patients. The guinea pigs then underwent tuberculin skin testing for infection. Only the control groups of guinea pigs from each study (no interventions used) provide the data for this analysis. The number of guinea pigs infected in each study is reported and correlated with Mycobacterium tuberculosis drug susceptibility relative to treatment.

RESULTS

Despite exposure to presumably infectious MDR-TB patients, infection percentages among guinea pigs ranged from 1% to 77% in the five experiments conducted. In one experiment in which guinea pigs were exposed to 27 MDR-TB patients newly started on effective treatment for 3 months, there was minimal transmission. In four other experiments with greater transmission, guinea pigs had been exposed to patients with unsuspected extensively drug-resistant tuberculosis who were not on effective treatment.

CONCLUSIONS

In this model, effective treatment appears to render MDR-TB patients rapidly non-infectious. Further prospective studies on this subject are needed.

Authors+Show Affiliations

Division of Pulmonary and Critical Care Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA.South African Medical Research Council, Pretoria, South Africa.South African Medical Research Council, Pretoria, South Africa.University of Pretoria, Pretoria, South Africa.South African Medical Research Council, Pretoria, South Africa.South African Medical Research Council, Pretoria, South Africa.South African Medical Research Council, Pretoria, South Africa.Department of Biostatistics, Harvard School of Public Health, Boston, Massachusetts, USA.Centers for Disease Control and Prevention, Atlanta, Georgia, USA.Division of Pulmonary and Critical Care Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA.

Pub Type(s)

Journal Article
Research Support, N.I.H., Extramural

Language

eng

PubMed ID

25189547

Citation

Dharmadhikari, A S., et al. "Rapid Impact of Effective Treatment On Transmission of Multidrug-resistant Tuberculosis." The International Journal of Tuberculosis and Lung Disease : the Official Journal of the International Union Against Tuberculosis and Lung Disease, vol. 18, no. 9, 2014, pp. 1019-25.
Dharmadhikari AS, Mphahlele M, Venter K, et al. Rapid impact of effective treatment on transmission of multidrug-resistant tuberculosis. Int J Tuberc Lung Dis. 2014;18(9):1019-25.
Dharmadhikari, A. S., Mphahlele, M., Venter, K., Stoltz, A., Mathebula, R., Masotla, T., van der Walt, M., Pagano, M., Jensen, P., & Nardell, E. (2014). Rapid impact of effective treatment on transmission of multidrug-resistant tuberculosis. The International Journal of Tuberculosis and Lung Disease : the Official Journal of the International Union Against Tuberculosis and Lung Disease, 18(9), 1019-25. https://doi.org/10.5588/ijtld.13.0834
Dharmadhikari AS, et al. Rapid Impact of Effective Treatment On Transmission of Multidrug-resistant Tuberculosis. Int J Tuberc Lung Dis. 2014;18(9):1019-25. PubMed PMID: 25189547.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Rapid impact of effective treatment on transmission of multidrug-resistant tuberculosis. AU - Dharmadhikari,A S, AU - Mphahlele,M, AU - Venter,K, AU - Stoltz,A, AU - Mathebula,R, AU - Masotla,T, AU - van der Walt,M, AU - Pagano,M, AU - Jensen,P, AU - Nardell,E, PY - 2014/9/6/entrez PY - 2014/9/6/pubmed PY - 2016/5/12/medline SP - 1019 EP - 25 JF - The international journal of tuberculosis and lung disease : the official journal of the International Union against Tuberculosis and Lung Disease JO - Int. J. Tuberc. Lung Dis. VL - 18 IS - 9 N2 - BACKGROUND: Effective treatment for drug-susceptible tuberculosis (TB) rapidly renders patients non-infectious, long before conversion of sputum acid-fast smear or culture to negative. Multidrug-resistant TB (MDR-TB) patients on treatment are currently assumed to remain infectious for months. While the resources required for prolonged hospitalization are a barrier to the scale-up of MDR-TB treatment, the safety of community treatment is clear. OBJECTIVES: To estimate the impact of treatment on infectiousness among MDR-TB patients. METHODS: A series of five human-to-guinea pig TB transmission studies was conducted to test various interventions for infection control. Guinea pigs in adjacent chambers were exposed to exhaust air from a hospital ward occupied by mostly sputum smear- and culture-positive MDR-TB patients. The guinea pigs then underwent tuberculin skin testing for infection. Only the control groups of guinea pigs from each study (no interventions used) provide the data for this analysis. The number of guinea pigs infected in each study is reported and correlated with Mycobacterium tuberculosis drug susceptibility relative to treatment. RESULTS: Despite exposure to presumably infectious MDR-TB patients, infection percentages among guinea pigs ranged from 1% to 77% in the five experiments conducted. In one experiment in which guinea pigs were exposed to 27 MDR-TB patients newly started on effective treatment for 3 months, there was minimal transmission. In four other experiments with greater transmission, guinea pigs had been exposed to patients with unsuspected extensively drug-resistant tuberculosis who were not on effective treatment. CONCLUSIONS: In this model, effective treatment appears to render MDR-TB patients rapidly non-infectious. Further prospective studies on this subject are needed. SN - 1815-7920 UR - https://www.unboundmedicine.com/medline/citation/25189547/Rapid_impact_of_effective_treatment_on_transmission_of_multidrug_resistant_tuberculosis_ L2 - https://www.ingentaconnect.com/openurl?genre=article&issn=1027-3719&volume=18&issue=9&spage=1019&aulast=Dharmadhikari DB - PRIME DP - Unbound Medicine ER -